Picture this:
A patient presents with palpitations, and you find this π on your evaluation.
Why (and how) is this an emergency? π€
A #tweetorial 𧡠1/7
A patient presents with palpitations, and you find this π on your evaluation.
Why (and how) is this an emergency? π€
A #tweetorial 𧡠1/7
To guide our thoughts, here are 2 tumor lysis syndrome (TLS) facts-
1) π Electrolyte balance across a membrane drives action potential
2) When cells die, they release electrolytes (& nucleic acids) from intra β‘οΈ extracellular space
𧡠2/7
1) π Electrolyte balance across a membrane drives action potential
2) When cells die, they release electrolytes (& nucleic acids) from intra β‘οΈ extracellular space
𧡠2/7
The lab criteria above π was created with treatment-related TLS in mindβ¦
but spontaneous TLS can actually have HYPOphosphatemia π€
Why can phosphorous be β¬οΈ in spontaneous TLS?
𧡠3/7
but spontaneous TLS can actually have HYPOphosphatemia π€
Why can phosphorous be β¬οΈ in spontaneous TLS?
𧡠3/7
Treatment-related TLS is due to cell death (β οΈ), compared toβ¦
π spontaneous TLS which is due to β¬οΈ cell turnover (πΆπ» & β οΈ)
Leukemic blasts (πΆπ») have ~4x normal phosphorous demands which β¬οΈ supply π€―
𧡠4/7
π spontaneous TLS which is due to β¬οΈ cell turnover (πΆπ» & β οΈ)
Leukemic blasts (πΆπ») have ~4x normal phosphorous demands which β¬οΈ supply π€―
𧡠4/7
Letβs break down TLS treatment into 2 parts-
1οΈβ£ Electrolyte management (HyperK and hypoCa/hypoPhos)
2οΈβ£ Uric acid management (fluids, allopurinol, +/- rasburicase)
𧡠5/7
1οΈβ£ Electrolyte management (HyperK and hypoCa/hypoPhos)
2οΈβ£ Uric acid management (fluids, allopurinol, +/- rasburicase)
𧡠5/7
π€ When should we use rasburicase?
π Conservative rasburicase use is non-inferior to aggressive use
In this studyπ rasburicase was only *considered* for those with:
- high risk features
- AND uric acid > 9 mg/dL
𧡠6/7
π Conservative rasburicase use is non-inferior to aggressive use
In this studyπ rasburicase was only *considered* for those with:
- high risk features
- AND uric acid > 9 mg/dL
𧡠6/7
Key takeaways:
π TLS is a syndrome of electrolyte abnormalities and kidney injury from β¬οΈ cell lysis
π© Watch out for β¬οΈ phos in STLS!
π Use rasburicase conservatively
β¦ and food for thought:
π€ As therapies improve, will β¬οΈ oncolytic effect lead to more TLS?
𧡠7/end
π TLS is a syndrome of electrolyte abnormalities and kidney injury from β¬οΈ cell lysis
π© Watch out for β¬οΈ phos in STLS!
π Use rasburicase conservatively
β¦ and food for thought:
π€ As therapies improve, will β¬οΈ oncolytic effect lead to more TLS?
𧡠7/end
Thanks for sticking around- I hope we all learned something new!
Thank you to @OllilaTom for peer review π
For a deeper dive, here are the full articles:
pubmed.ncbi.nlm.nih.gov/23211092/
pubmed.ncbi.nlm.nih.gov/28077046/
and images:
ahajournals.org/doi/10.1161/ciβ¦
imagebank.hematology.org/image/2201/ph-β¦
Thank you to @OllilaTom for peer review π
For a deeper dive, here are the full articles:
pubmed.ncbi.nlm.nih.gov/23211092/
pubmed.ncbi.nlm.nih.gov/28077046/
and images:
ahajournals.org/doi/10.1161/ciβ¦
imagebank.hematology.org/image/2201/ph-β¦
Thank you to @Berninini and @ajperissinotti for the excellent study above π
Looking forward to hearing what others would add!
@dhughesPharmD @lynnettehenshaw @JPatel_PharmD @JessicaFRx1 @ManniMD1 @tony_breu @HemeOncPharm @OncBrothers @amarkelkar @DxRxEdu @rabihmgeha
Looking forward to hearing what others would add!
@dhughesPharmD @lynnettehenshaw @JPatel_PharmD @JessicaFRx1 @ManniMD1 @tony_breu @HemeOncPharm @OncBrothers @amarkelkar @DxRxEdu @rabihmgeha
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